1. < Kidney & Bladder

Concern about Globulin-Predominant UPEP Proteinuria Pattern

Posted by stlmark @stlmark, 5 days ago

Hello everyone,

I'm hoping to get some insight or shared experiences regarding a somewhat unusual finding in my 24-hour urine protein electrophoresis (UPEP). No apparent monoclonal peak was observed.

While my total 24-hour urine protein was only mildly elevated at 168 mg/24h, the composition of the proteins is what's been worrying me.

Here's the breakdown:
Albumin: 25.8%
Alpha-1 globulin: 33.3%
Alpha-2 globulin: 19.0%
Beta globulin: 12.1%
Gamma globulin: 9.8%

So over 70% of my urinary proteins were globulins, not albumin. From what I've read—this could suggest kidney damage, which may reflect proximal tubule dysfunction or other issues. I've also read that in normal physiology, albumin should be the predominant urinary protein when protein is present, and globulins (especially alpha and beta) are generally absent or only found in trace amounts.

My nephrologist has reviewed this and does not believe there is kidney disease, and all other labs (eGFR, creatinine, urinalysis) have been normal or only mildly abnormal. Still, I’m concerned that the protein pattern may reflect an early or subtle form of kidney involvement, especially since I’ve also had persistent right-sided flank pain, foamy urine, and cold extremities.

Has anyone else had globulin-dominant UPEP protein composition with a normal or mildly elevated protein level? Could this still suggest some kind of kidney issue that warrants closer follow-up?

Thanks for reading—I’d be grateful for any insights.

Warmly,
Mark

Interested in more discussions like this? Go to the Kidney & Bladder Support Group.

Mentor
Cheryl, Volunteer Mentor | @cehunt57 | 4 days ago

@stlmark Welcome to Mayo Clinic Connect. I have CKD stage 4 (chronic kidney disease). I also have albuminurea (protein in the urine) that my nephrologist keeps a close eye on. Having said that, I am unfamiliar with the UPEP protein composition that you refer to. (It is all Greek to me, literally!) Hopefully another member who has some experience with this will respond soon. In the mean time, do you have a good working relationship with your nephrologist and do you trust this provider?

REPLY
Mentor
Ginger, Volunteer Mentor | @gingerw | 4 days ago

@stlmark Let me also add my welcome to Mayo Clinic Connect!

As @cehunt Cheryl mentioned, is your nephrologist a trusted member of your medical team? What was the purpose of your 24 hour collection? And, seeing that the balance of your labs are in an acceptable range, what is your eGFR? So many times we want to take a singular result and pronounce possible conditions, but in truth it is important to look at the overall results, and trends.

For me, my 24 hour collections since 1988 showed high levels of protein. This was interpreted as a result of my systemic Lupus, and the doctors went no further, for years. In 2015 I had a kidney biopsy done due to concerning values, and was diagnosed with a very rare kidney condition. This is an example of what I was referring to above.

Is this the first time you have had this test? High globulins in a UPEP can indicate inflammation of infection, also, so if you have been sick or not feeling well, any test results can be skewed. Has your nephrologist talked to you about repeating the test?
Ginger

REPLY
Please sign in or register to post a reply.